Longitudinal observations on a selected group of local health departments: a preliminary report

A study is in progress to document changes in selected public health departments over the past decade and to use those observations for proposing an assessment protocol that may be helpful in measuring progress toward achieving one of the Health Objectives for the Nation for the Year 2000. Objective no. 8.14 reads: "Increase to at least 90 percent the proportion of people served by a local health department that is effectively carrying out the core functions of public health." The study re-surveys a group of 14 departments that were the subjects of intensive case studies between 1979 and 1981. Some preliminary observations from follow-up study of these departments in 1992 include: growth in budget and staff and even larger growth in pressure for services, especially for personal health care; reorganization that splits away some programs of comprehensive ambulatory care and responsibility for public hospitals, while increasing the aggregation of human service agencies, including public health, under locally organized umbrella agencies; increase in preventive, screening, and categorical programs under public health sponsorship; drastic change in patterns of financing, featuring nearly total loss of direct federal grants, and increase in fee income; increase in the number of community and migrant health centers in the public health jurisdictions under study; diminished collaborative interaction with private practitioners; and continued close collaboration between health departments and community health centers in several communities. The implications of these changes are discussed. Subsequent reports will be based on efforts to measure the impact of specific events of the 1980s on public health performance, and will describe experience with a community-based surveillance approach for assessing public health performance.